# Total Sealing Technique: A Preliminary Study on a Novel Surgical Approach That Significantly Reduces the Incidence of Upper Extremity Lymphedema Following Axillary Dissection in Patients with Breast Cancer

## TL;DR

A new surgical technique called Total Sealing Technique (TST) significantly reduces the risk of lymphedema in breast cancer patients after axillary dissection.

## Contribution

The TST uses a bipolar-vessel-sealing system to minimize lymphatic leakage and lower lymphedema incidence compared to conventional methods.

## Key findings

- The TST group had a 2.9% incidence of lymphedema versus 22.2% in the conventional group.
- The TST showed no significant association between lymphedema and risk factors like chemotherapy or age.
- The TST is a reliable and simple procedure once surgeons are trained.

## Abstract

Breast cancer-related lymphedema (BCRL), characterized by lymphatic fluid accumulation in the upper extremities following breast cancer treatment, significantly affects the quality of life of survivors of breast cancer. In a previous study, we introduced a novel surgical procedure, the Total Sealing Technique (TST), which utilizes a bipolar-vessel-sealing system (LigaSure™ Exact Dissector, Medtronic plc, Dublin, Ireland) to reduce lymphatic leakage during axillary lymph node dissection (ALND) for breast cancer. After observing that patients who underwent this procedure had fewer cases of BCRL, we evaluated its incidence. A comparative analysis of 36 patients who underwent conventional electrocautery (CONV) and 35 who underwent the TST revealed that the TST significantly reduced the incidence of BCRL. Once the surgeon becomes accustomed to it, the TST becomes a simple surgical procedure that provides reliable outcomes regardless of the surgeon, timing, or location, suggesting that it has the potential to transform axillary dissection in breast cancer surgery.

Background/Objectives: In a previous study, we reported a novel surgical procedure called the Total Sealing Technique (TST), which uses a bipolar-vessel-sealing system to reduce lymphatic leakage during axillary dissection for breast cancer. Follow-up observations showed a lower incidence of breast cancer-related lymphedema (BCRL) in patients in the TST group. Therefore, in this current study, we aim to investigate and compare the incidence of BCRL between two groups (TST and conventional electrocautery (CONV)) and discuss why the incidence of BCRL was significantly lower in the TST group than in the CONV group. Methods: We conducted a comparative analysis of 36 patients who underwent total mastectomy with axillary lymph node dissection (ALND) using the CONV procedure during the first three years and 35 patients who underwent the same procedure using the TST during the subsequent three years. We evaluated the incidence of BCRL and its association with the risk factors in both groups. Results: The incidence of BCRL was 2.9% in the TST group and 22.2% in the CONV groups, respectively (p = 0.028). In the TST group, no significant association was found between the incidence of BCRL and known risk factors. However, in the CONV group, the incidence of BCRL was significantly higher in younger patients and in those who received neoadjuvant or postoperative chemotherapy, a taxane-containing regimen, or >600 mL of drainage. Conclusions: The TST with bipolar-vessel-sealing system (LigaSure™ Exact Dissector) significantly reduces BCRL incidence, suggesting that it may become an important surgical procedure for axillary dissection in breast cancer in the future.